title: Clinical and bacteriological effects of pivmecillinam for ESBL-producing Escherichia coli or Klebsiella pneumoniae in urinary tract infections.
abstract: OBJECTIVE
  The prevalence of urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is increasing and the therapeutic options are limited, especially in primary care. Recent indications have suggested pivmecillinam to be a suitable option. Here, we evaluated the clinical and bacteriological effects of pivmecillinam in UTIs caused by ESBL-producing Enterobacteriaceae.
  
  
  METHODS
  We carried out a prospective follow-up of 39 patients diagnosed with UTI caused by ESBL-producing Enterobacteriaceae, initiated on pivmecillinam. The patients were from general practice (n = 29) or admitted to hospitals (n = 10) in the Copenhagen area, Denmark (n = 30) or Halland, Sweden (n = 9). Both patients and physicians were asked to complete a questionnaire on the pretreatment signs and symptoms. Patients were asked to send in two more urine samples for culture examination, together with questionnaires for clinical effect, 2-6 and 10-20 days, respectively, after end of treatment.
  
  
  RESULTS
  Of the 39 patients included, 30 received a treatment regimen of 400 mg of pivmecillinam three times a day and 9 received 200 mg three times a day. All isolates were susceptible to mecillinam. The bacteriological cure rate was 79% (31/39); 80% (24/30) and 78% (7/9) for 400 and 200 mg three times a day, respectively. Relapse, i.e. ESBL-producing bacteria in the second control urine after previous bacteriological cure, was seen in five patients. Clinical cure was evaluable in 19 patients; 16 had a clinical effect (84%).
  
  
  CONCLUSIONS
  Pivmecillinam was proven bacteriologically and clinically effective for treatment of lower UTIs caused by ESBL-producing Enterobacteriaceae.
authors.affiliation: Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark.
authors.forename: Filip
authors.initials: F
authors.lastname: Jansåker
authors.forename: Niels
authors.initials: N
authors.lastname: Frimodt-Møller
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Sjögren
authors.forename: Jenny
authors.initials: J
authors.lastname: Dahl Knudsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000561:Amdinocillin Pivoxil / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003718:Denmark; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011795:Surveys and Questionnaires; D013548:Sweden; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D014556:Urine / Q000382:microbiology; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D000561:Amdinocillin Pivoxil; D001618:beta-Lactamases
keywords: Enterobacteriaceae; antimicrobal therapy; community-acquired infections; mecillinam; multidrug resistance